A provisional diagnosis of osteoclastoma of the ulna was followed by a course of deep X-ray therapy (200 K.V., 20 m.a., 50 f.s.d., 1.0 mm. Cu plus 1.0 mm. AI filter, and a H.V.L. 1.7 mm. Cu, with a total tumour dose of 2,000 r given in ten daily treatments of 200 r per treatment through a portal of 10 cm. diameter) without the aid of a biopsy or surgical intervention. One course of treatment was administered from the 28 August 1946 to 10 September 1946. The subsequent radiographs reveal the typical response of an osteoclastoma to a course of radiotherapy, thus clinching the diagnosis. The patIent is well and symptom-free.
Gouty (uric acid) diathesis is not infrequent amongst Indians (Mahommedan as well as Hindu) residing in South Africa. Because Hindus are affected in about the same proportion as Mahommedans the accepted theories of the past about the causation of gout should be revised. The Mahommedans usually abstain from all alcohol and the Hindus abstain from all animal protein. The blood uric acid is raised in a large proportion of cases, but not every case of hyperuricaemia exhibits clinical signs of gout. The blood sedimentation rate was usually increased in the acute and subacute cases, while it was normal in most of the chronic cases. Gouty arthritis may start in any joint. The polyarticular type is common. From purely clinical observations the writer is of the opinion that the gouty diathesis is caused by some liver dysfunction (inherited or acquired) the progress of which should be controlled by the Ehrlich test. Colchicum is the only drug effective in acute case: and of good value also in chronic cases of the gouty diathesis. Its pharmacological action is not clear, but the writer is inclined to suggest (from purely clinical observations) that it acts on the liver cells: relapses or exacerbations of symptoms resulting from vitamin B complex injections have not been seen by the author. Brewer's yeast in large doses proved very beneficial and should be taken over many weeks. For swelling and pain of feet and hands galvanic baths are recommended. The diet should be a high protein and high carbohydrate one, fat intake to be reduced to a bare minimum. The diathesis cannot be eliminated but its manifestations can be treated successfully if the patient co-operates. The majority of gouty patients seen by the writer were not affected by changes in the weather.